Does Family Doctor Contracting Improve the Health of the Elderly: An Empirical Study from Beijing, China

Bo Lv,1,2,* Zhaoyang Wang,1,* Kai Meng1,2 1School of Public Health, Capital Medical University, Beijing, People’s Republic of China; 2Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Kai Meng, Email mengkai@ccmu.edu.cnBackground: Amid rapid population aging and the rising prevalence of chronic diseases in China, family doctor contract services have become a key healthcare reform aimed at strengthening primary care. The elderly are a priority group for these services. This study examines their specific relationship on the health of older adults, providing a scientific basis for expanding the services and improving health outcomes in this population.Methods: This study employed a cross-sectional research design. A cluster sampling method was used to select 2052 elderly individuals aged 60 years and above from a community in District F, Beijing. A total of 1814 valid questionnaires were collected, yielding an effective response rate of 88.40%. To analyze the relationship between family doctor contracting and the health status of the elderly, the PSM model was applied to construct a control group with similar observable characteristics, thereby addressing self-selection bias. Additionally, the 2SLS model was adopted, incorporating instrumental variables to control for potential endogeneity issues.Results: The proportion of elderly individuals who signed contracts with family doctors was relatively low, at 21.72%. The average self-rated physical health score was 10.18. In the PSM analysis, the effect sizes for kernel matching, k-nearest neighbor matching, and radius matching were − 0.17, − 0.09, and − 0.12, respectively. The preference for primary medical and health institutions as the first point of care passed the weak instrumental variable test (F=36.25). The regression coefficient derived from the 2SLS method was − 0.02.Conclusion: The willingness to sign up for family doctor services among the elderly in Beijing remains generally low. Health status is influenced by chronic disease, activity, education, and occupation, yet enrollment alone yields no significant improvement. This points to ineffective service engagement. Stronger policy authority, better mechanisms, aligned services, and enhanced execution and trust are urgently needed to realize family doctors’ role.Keywords: elderly, family doctor contract, health, propensity score matching, two-stage least squares